Throughout the past decade, clinicians have promoted the use of scientific evidence to support clinical decisions in clinical settings. Sackett et al1 defined evidence-based medicine as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."^(p71)

In community settings, evidence comes from a variety of sources (eg, research studies, work experience, community leaders). Evidence can be used to influence health policies, which will ultimately influence the health of communities and families. Adapting Sackett et al's1 definition, Rychenyk et al2 define evidence-based public health as "a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods."^(p538) This issue illustrates how evidence can be used in a variety of community settings to enhance the health of families and communities.

In the first article, Butler uses evidence to develop a toolkit to prevent meningococcal meningitis in college students. College freshman living in dorms are at high risk for acquiring meningococcal meningitis. Even though the incidence of disease is small, vaccination can prevent up to 83% of cases among adolescents and college students. Butler provides a step-by-step approach to tool kit development that could be used in a variety of community settings.

Alternative therapies have received a lot of attention in the past decade. One such therapy, acupuncture, has been used for more than 2000 years in Chinese medicine. One criticism of the use of alternative therapies such as acupuncture is the lack of research to support its use. Courbasson et al explore the use of acupuncture as adjunct therapy to a 21-day structured treatment for substance abuse. Many people relapse after treatment because of anxiety or depression. Psychotherapy and medication can help them cope with the anxiety and depression, but some people return to substance abuse. In this study, acupuncture showed promise in decreasing anxiety and depression in the sample.

Weeks examines the characteristics of community-dwelling elderly veterans and other seniors to determine who are at increased risk of falling and becoming injured after the fall. More than one third of adults, 65 years and older, fall each year.3 About 30% of those who fall will have moderate to severe injuries, possibly leading to decreased mobility and death.4 Veterans with service-related disabilities may be at higher risk for falls. In addition, research has shown that women are more likely to fall than men. Weeks compared males and females to determine the risk of falls and found that veterans indeed were at a higher risk of falling and becoming injured than other community-dwelling seniors.

In the United States, secondhand smoke causes about 3,400 lung cancer deaths and up to 39,000 heart-related deaths per year in adult nonsmokers.5 Cramer et al evaluate the efforts of a community-based coalition to educate and change attitudes regarding exposure to secondhand smoke and to promote policies for tobacco-free environments. As a result of the work of the coalition, attitudes improved and more voluntary smoke-free practices were established.

Physical activity is highly recommended for all of us, including those with neurodegenerative diseases such as multiple sclerosis (MS). Symptoms of MS can lead to a decrease in physical activity. Measuring physical activity can be challenging in people with MS. Gosney et al compare self-report and objective measures of physical activity in people with MS. Results showed that the use of objective devices was valid with patients with MS.

Researchers have suggested that exposure to influenza during pregnancy can lead to complications such as neural tube defects and even schizophrenia in offspring. Venables et al present a provocative article looking at the impact of influenza on the complications of pregnancy and birth. The researchers found that mothers exposed to the Hong Kong influenza virus (1968-1970) during the second and third trimesters were more likely to have delivery complications than those who were not exposed. The authors' findings support the administration of influenza vaccines for pregnant women.

Evidence-based practice is essential to develop quality community-based programs and interventions. This issue provides a broad perspective of evidence for promoting the health of families and communities.

Sharon E. Lock, PhD, ARNP

Issue Editor, Associate Professor, University of Kentucky College of Nursing, Lexington, Kentucky

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